|
PR 1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS
|
Professional
|
Both
|
$1,774.00
|
|
|
Service Code
|
HCPCS 54326
|
| Min. Negotiated Rate |
$709.60 |
| Max. Negotiated Rate |
$1,664.63 |
| Rate for Payer: Aetna Commercial |
$1,205.73
|
| Rate for Payer: Aetna Medicare |
$935.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,295.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,205.73
|
| Rate for Payer: BCBS Complete |
$709.60
|
| Rate for Payer: BCBS MAPPO |
$899.80
|
| Rate for Payer: BCN Medicare Advantage |
$899.80
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cofinity Commercial |
$1,295.71
|
| Rate for Payer: Cofinity Commercial |
$1,205.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$899.80
|
| Rate for Payer: Healthscope Commercial |
$1,439.68
|
| Rate for Payer: Healthscope Commercial |
$1,664.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$944.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,153.10
|
| Rate for Payer: Nomi Health Commercial |
$1,079.76
|
| Rate for Payer: PACE SWMI |
$899.80
|
| Rate for Payer: PHP Medicare Advantage |
$899.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,153.10
|
| Rate for Payer: Priority Health Medicare |
$899.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$899.80
|
| Rate for Payer: UHC Medicare Advantage |
$899.80
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 54322
|
| Min. Negotiated Rate |
$746.55 |
| Max. Negotiated Rate |
$3,250.00 |
| Rate for Payer: Aetna Commercial |
$1,000.38
|
| Rate for Payer: Aetna Medicare |
$776.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.38
|
| Rate for Payer: BCBS Complete |
$2,000.00
|
| Rate for Payer: BCBS MAPPO |
$746.55
|
| Rate for Payer: BCN Medicare Advantage |
$746.55
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$1,075.03
|
| Rate for Payer: Cofinity Commercial |
$1,000.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.55
|
| Rate for Payer: Healthscope Commercial |
$1,381.12
|
| Rate for Payer: Healthscope Commercial |
$1,194.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,250.00
|
| Rate for Payer: Nomi Health Commercial |
$895.86
|
| Rate for Payer: PACE SWMI |
$746.55
|
| Rate for Payer: PHP Medicare Advantage |
$746.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,250.00
|
| Rate for Payer: Priority Health Medicare |
$746.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.55
|
| Rate for Payer: UHC Medicare Advantage |
$746.55
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS
|
Professional
|
Both
|
$2,012.00
|
|
|
Service Code
|
HCPCS 54324
|
| Min. Negotiated Rate |
$804.80 |
| Max. Negotiated Rate |
$1,710.53 |
| Rate for Payer: Aetna Commercial |
$1,238.98
|
| Rate for Payer: Aetna Medicare |
$961.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.98
|
| Rate for Payer: BCBS Complete |
$804.80
|
| Rate for Payer: BCBS MAPPO |
$924.61
|
| Rate for Payer: BCN Medicare Advantage |
$924.61
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cofinity Commercial |
$1,331.44
|
| Rate for Payer: Cofinity Commercial |
$1,238.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.61
|
| Rate for Payer: Healthscope Commercial |
$1,479.38
|
| Rate for Payer: Healthscope Commercial |
$1,710.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,307.80
|
| Rate for Payer: Nomi Health Commercial |
$1,109.53
|
| Rate for Payer: PACE SWMI |
$924.61
|
| Rate for Payer: PHP Medicare Advantage |
$924.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,307.80
|
| Rate for Payer: Priority Health Medicare |
$924.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.61
|
| Rate for Payer: UHC Medicare Advantage |
$924.61
|
|
|
PR 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99460
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$161.63 |
| Rate for Payer: Aetna Commercial |
$117.08
|
| Rate for Payer: Aetna Medicare |
$90.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.08
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$87.37
|
| Rate for Payer: BCN Medicare Advantage |
$87.37
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$125.81
|
| Rate for Payer: Cofinity Commercial |
$117.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.37
|
| Rate for Payer: Healthscope Commercial |
$161.63
|
| Rate for Payer: Healthscope Commercial |
$139.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.70
|
| Rate for Payer: Nomi Health Commercial |
$104.84
|
| Rate for Payer: PACE SWMI |
$87.37
|
| Rate for Payer: PHP Medicare Advantage |
$87.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$87.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.37
|
| Rate for Payer: UHC Medicare Advantage |
$87.37
|
|
|
PR 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 99463
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$188.85 |
| Rate for Payer: Aetna Commercial |
$136.79
|
| Rate for Payer: Aetna Medicare |
$106.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.79
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: BCBS MAPPO |
$102.08
|
| Rate for Payer: BCN Medicare Advantage |
$102.08
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Cofinity Commercial |
$136.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.08
|
| Rate for Payer: Healthscope Commercial |
$163.33
|
| Rate for Payer: Healthscope Commercial |
$188.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.80
|
| Rate for Payer: Nomi Health Commercial |
$122.50
|
| Rate for Payer: PACE SWMI |
$102.08
|
| Rate for Payer: PHP Medicare Advantage |
$102.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health Medicare |
$102.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.08
|
| Rate for Payer: UHC Medicare Advantage |
$102.08
|
|
|
PR 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 99223
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$304.88 |
| Rate for Payer: Aetna Commercial |
$220.83
|
| Rate for Payer: Aetna Medicare |
$171.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.83
|
| Rate for Payer: BCBS Complete |
$141.20
|
| Rate for Payer: BCBS MAPPO |
$164.80
|
| Rate for Payer: BCN Medicare Advantage |
$164.80
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$237.31
|
| Rate for Payer: Cofinity Commercial |
$220.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.80
|
| Rate for Payer: Healthscope Commercial |
$304.88
|
| Rate for Payer: Healthscope Commercial |
$263.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.45
|
| Rate for Payer: Nomi Health Commercial |
$197.76
|
| Rate for Payer: PACE SWMI |
$164.80
|
| Rate for Payer: PHP Medicare Advantage |
$164.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health Medicare |
$164.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.80
|
| Rate for Payer: UHC Medicare Advantage |
$164.80
|
|
|
PR 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 99222
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$228.81 |
| Rate for Payer: Aetna Commercial |
$165.73
|
| Rate for Payer: Aetna Medicare |
$128.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.73
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$123.68
|
| Rate for Payer: BCN Medicare Advantage |
$123.68
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$178.10
|
| Rate for Payer: Cofinity Commercial |
$165.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.68
|
| Rate for Payer: Healthscope Commercial |
$197.89
|
| Rate for Payer: Healthscope Commercial |
$228.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.65
|
| Rate for Payer: Nomi Health Commercial |
$148.42
|
| Rate for Payer: PACE SWMI |
$123.68
|
| Rate for Payer: PHP Medicare Advantage |
$123.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$123.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.68
|
| Rate for Payer: UHC Medicare Advantage |
$123.68
|
|
|
PR 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 99221
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$145.45 |
| Rate for Payer: Aetna Commercial |
$105.35
|
| Rate for Payer: Aetna Medicare |
$81.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.35
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$78.62
|
| Rate for Payer: BCN Medicare Advantage |
$78.62
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$113.21
|
| Rate for Payer: Cofinity Commercial |
$105.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.62
|
| Rate for Payer: Healthscope Commercial |
$145.45
|
| Rate for Payer: Healthscope Commercial |
$125.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.05
|
| Rate for Payer: Nomi Health Commercial |
$94.34
|
| Rate for Payer: PACE SWMI |
$78.62
|
| Rate for Payer: PHP Medicare Advantage |
$78.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Medicare |
$78.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.62
|
| Rate for Payer: UHC Medicare Advantage |
$78.62
|
|
|
PR 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 99468
|
| Min. Negotiated Rate |
$670.00 |
| Max. Negotiated Rate |
$1,555.63 |
| Rate for Payer: Aetna Commercial |
$1,126.78
|
| Rate for Payer: Aetna Medicare |
$874.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,210.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,126.78
|
| Rate for Payer: BCBS Complete |
$670.00
|
| Rate for Payer: BCBS MAPPO |
$840.88
|
| Rate for Payer: BCN Medicare Advantage |
$840.88
|
| Rate for Payer: Cash Price |
$1,340.00
|
| Rate for Payer: Cash Price |
$1,340.00
|
| Rate for Payer: Cofinity Commercial |
$1,210.87
|
| Rate for Payer: Cofinity Commercial |
$1,126.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$840.88
|
| Rate for Payer: Healthscope Commercial |
$1,345.41
|
| Rate for Payer: Healthscope Commercial |
$1,555.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$882.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,088.75
|
| Rate for Payer: Nomi Health Commercial |
$1,009.06
|
| Rate for Payer: PACE SWMI |
$840.88
|
| Rate for Payer: PHP Medicare Advantage |
$840.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,088.75
|
| Rate for Payer: Priority Health Medicare |
$840.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$840.88
|
| Rate for Payer: UHC Medicare Advantage |
$840.88
|
|
|
PR 1ST PSYCHIATRIC COLLAB CARE MGMT 1ST 70 MINS
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 99492
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$119.69
|
| Rate for Payer: Aetna Medicare |
$92.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.69
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: BCBS MAPPO |
$89.32
|
| Rate for Payer: BCN Medicare Advantage |
$89.32
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$128.62
|
| Rate for Payer: Cofinity Commercial |
$119.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Healthscope Commercial |
$142.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.75
|
| Rate for Payer: Nomi Health Commercial |
$107.18
|
| Rate for Payer: PACE SWMI |
$89.32
|
| Rate for Payer: PHP Medicare Advantage |
$89.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.75
|
| Rate for Payer: Priority Health Medicare |
$89.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.32
|
| Rate for Payer: UHC Medicare Advantage |
$89.32
|
|
|
PR 1ST/SBSQ PSYCH COLLAB CARE MGMT EA ADDL 30 MINS
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 99494
|
| Min. Negotiated Rate |
$38.06 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$39.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.00
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$38.06
|
| Rate for Payer: BCN Medicare Advantage |
$38.06
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$54.81
|
| Rate for Payer: Cofinity Commercial |
$51.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.06
|
| Rate for Payer: Healthscope Commercial |
$60.90
|
| Rate for Payer: Healthscope Commercial |
$70.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.85
|
| Rate for Payer: Nomi Health Commercial |
$45.67
|
| Rate for Payer: PACE SWMI |
$38.06
|
| Rate for Payer: PHP Medicare Advantage |
$38.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health Medicare |
$38.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.06
|
| Rate for Payer: UHC Medicare Advantage |
$38.06
|
|
|
PR 2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 90650
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$181.35 |
| Rate for Payer: Aetna Medicare |
$139.50
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.35
|
|
|
PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 90649
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$170.95 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.95
|
|
|
PR 5% DEXTROSE IN LAC RINGERS
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J7121
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
PR 9VHPV VACC 2/3 DOSE SCHED IM USE
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 90651
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
|
|
PR AAA REPAIR,AORTO-AORTIC TUBE PROSTH
|
Professional
|
Both
|
$3,937.00
|
|
|
Service Code
|
HCPCS 34800
|
| Min. Negotiated Rate |
$1,574.80 |
| Max. Negotiated Rate |
$2,559.05 |
| Rate for Payer: Aetna Medicare |
$1,968.50
|
| Rate for Payer: BCBS Complete |
$1,574.80
|
| Rate for Payer: Cash Price |
$3,149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,559.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,559.05
|
|
|
PR AAA REPAIR,MODULR BIFURCATED PROSTH
|
Professional
|
Both
|
$2,555.00
|
|
|
Service Code
|
HCPCS 34802
|
| Min. Negotiated Rate |
$1,022.00 |
| Max. Negotiated Rate |
$1,660.75 |
| Rate for Payer: Aetna Medicare |
$1,277.50
|
| Rate for Payer: BCBS Complete |
$1,022.00
|
| Rate for Payer: Cash Price |
$2,044.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.75
|
|
|
PR AAA REPAIR,MODULR BIFUR PROSTH,2-DOCK
|
Professional
|
Both
|
$2,622.00
|
|
|
Service Code
|
HCPCS 34803
|
| Min. Negotiated Rate |
$1,048.80 |
| Max. Negotiated Rate |
$1,704.30 |
| Rate for Payer: Aetna Medicare |
$1,311.00
|
| Rate for Payer: BCBS Complete |
$1,048.80
|
| Rate for Payer: Cash Price |
$2,097.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,704.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,704.30
|
|
|
PR AAA REPAIR,UNIBODY BIFURCATED PROSTH
|
Professional
|
Both
|
$5,512.00
|
|
|
Service Code
|
HCPCS 34804
|
| Min. Negotiated Rate |
$2,204.80 |
| Max. Negotiated Rate |
$3,582.80 |
| Rate for Payer: Aetna Medicare |
$2,756.00
|
| Rate for Payer: BCBS Complete |
$2,204.80
|
| Rate for Payer: Cash Price |
$4,409.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,582.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,582.80
|
|
|
PR AAA REPR,1ST VESSEL,EXTENSION PROSTH
|
Professional
|
Both
|
$2,698.00
|
|
|
Service Code
|
HCPCS 34825
|
| Min. Negotiated Rate |
$1,079.20 |
| Max. Negotiated Rate |
$1,753.70 |
| Rate for Payer: Aetna Medicare |
$1,349.00
|
| Rate for Payer: BCBS Complete |
$1,079.20
|
| Rate for Payer: Cash Price |
$2,158.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,753.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.70
|
|
|
PR AAA REPR,ADD VESSEL,EXTENSION PROSTH
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 34826
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$283.40 |
| Rate for Payer: Aetna Medicare |
$218.00
|
| Rate for Payer: BCBS Complete |
$174.40
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.40
|
|
|
PR ABATACEPT INJECTION
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS J0129
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$59.11
|
| Rate for Payer: Aetna Medicare |
$45.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.52
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$44.11
|
| Rate for Payer: BCN Medicare Advantage |
$44.11
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$59.11
|
| Rate for Payer: Cofinity Commercial |
$63.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$70.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Nomi Health Commercial |
$52.93
|
| Rate for Payer: PACE SWMI |
$44.11
|
| Rate for Payer: PHP Medicare Advantage |
$44.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$44.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.11
|
| Rate for Payer: UHC Medicare Advantage |
$44.11
|
|
|
PR ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 38747
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$476.49 |
| Rate for Payer: Aetna Commercial |
$345.13
|
| Rate for Payer: Aetna Medicare |
$267.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.13
|
| Rate for Payer: BCBS Complete |
$193.20
|
| Rate for Payer: BCBS MAPPO |
$257.56
|
| Rate for Payer: BCN Medicare Advantage |
$257.56
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$370.89
|
| Rate for Payer: Cofinity Commercial |
$345.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$412.10
|
| Rate for Payer: Healthscope Commercial |
$476.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.95
|
| Rate for Payer: Nomi Health Commercial |
$309.07
|
| Rate for Payer: PACE SWMI |
$257.56
|
| Rate for Payer: PHP Medicare Advantage |
$257.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.95
|
| Rate for Payer: Priority Health Medicare |
$257.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.56
|
| Rate for Payer: UHC Medicare Advantage |
$257.56
|
|
|
PR ABDOMINOPLASTY (2HRS)
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 00364
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,723.80 |
| Rate for Payer: Aetna Medicare |
$1,326.00
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,723.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
|
|
PR ABDOMINOPLASTY (3HRS)
|
Professional
|
Both
|
$4,284.00
|
|
|
Service Code
|
HCPCS 00365
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,713.60 |
| Max. Negotiated Rate |
$2,784.60 |
| Rate for Payer: Aetna Medicare |
$2,142.00
|
| Rate for Payer: BCBS Complete |
$1,713.60
|
| Rate for Payer: Cash Price |
$3,427.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,784.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,784.60
|
|
